Tag Archives: medicare

All That You Need To Know About Patient Readmission Rates

What is Patient Readmission?

Patient readmission happens when a discharged patient is again admitted to the hospital within a specified period. CMS used different time frames for research purposes, the most common being 30-days, 90-days and 1-year readmission. They define patient readmission as “An admission to an acute care hospital within 30 days of discharge from the same or another acute care hospital”. It uses an “all-cause” definition, meaning that the cause of the readmission need not be related to the cause of the initial hospitalization. The CMS set the time frame to 30 days because readmission during this time is a result of the care given at the hospital and how well they coordinated the discharges.

Why does Patient Readmission happen?

Before knowing why readmission happens, there are two terminologies that we must know to understand it better.

Index Hospitalization – The original hospital stay i.e when a patient gets admitted for a treatment in a hospital is “index admission”.

Hospital Readmission Rates – The rate at which a hospital readmitted its patients is a “hospital readmission rate”.  In other terms, it is an outcome or a quality measure of care given by health systems.

Here are the top four reasons for patient readmissions,

  1. Importance of paying heed to the physician – Mr. Hayden got admitted to a hospital for a knee surgery. The physician advised him to take complete rest. He did not listen to the physician and strained himself resulting in severe leg pain. Now Mr.Hayden is then re-admitted to the hospital. In this case, the patient should have paid attention to his physician’s advice.
  2. Recovery Instructions – Dr. Adams is a cardiologist. He performed an open heart surgery on one of his patients. Since Dr. Adams was busy with many other surgeries on the same day he couldn’t give the patient instructions regarding post-surgery clinical exercises. He entrusts a nurse with the job. The nurse forgets to instruct the patient about the prescribed exercises. The patient then gets readmitted to the hospital complaining of chest pain. It is the responsibility of the specialist to give the required instructions to his patient and help them recover quicker.
  3. Communication between the patient and the specialist – Mr. Mark gets admitted to the hospital for ulcer treatment. The patient fails to give his complete health problems to the specialist. The specialist does not probe much and gives the usual treatment. Mark is fine for a week after discharge but is then re-admitted for the same problem. It is important for the patient to share all his problems with the specialist and it is the duty of the specialist to understand the complete health history of the patient.
  4. Continuous care to the patient after discharge – Dr. George is an Orthopedic specialist. His patient is suffering from arthritis. The patient needs continuous monitoring and care. The specialist is mostly not reachable over the phone for doubts. Here arises the need for technology, a software that can help both the patient and the specialist in continuous assessment.

Patient readmission risks

Readmission rates decide the quality of care given by the physicians. The CMS introduced the Patient Protection and Affordable Care Act in 2010 penalizing the health systems having higher than expected readmission rates through the Hospital Readmission Reduction Program. They specifically designed the program for incentivizing hospitals that had higher readmission rates of 20% in 2010. CMS reduced the reimbursements of the hospitals depending on the rate of the breach which was effective in reducing the readmission rates by 2% in 2013.

Ways to Reduce Patient Readmission Rates

A study presented by the Harvard Business Review found that on average, a hospital can reduce its readmission rates by 5% if it simply prioritized communication with patients while also complying with evidence-based standards of care. The following steps are a great initiative in cutting down the readmission rates.

  • Scheduling follow-up appointments After a patient gets discharged it is essential to get in touch with him to inquire about his well-being. The appointments need not be face-to-face always. The physicians can conduct appointments through audio or video calls or sometimes even through messaging or e-mails. It will help the physician in knowing how well the patient is after the treatment or surgery.
  • Long-term relationships with patients – Patient engagement is the key to reduce patient readmission rates. Rehabilitation programs, good nursing team, home care, wellness programs etc can improve patient engagement and thus reduce readmissions.
  • Technology to play a vital role – A software to monitor the patients continuously can really help in solving the readmission rates problem in a cost-effective way. It also provides many other advantages and reduces manual work.

How can technology help in curbing readmission risks?

Information Technology is everywhere, so why not in healthcare? HealthViewX Care Management Solution helps the providers in monitoring and providing care to patients anywhere. It allows the provider to create a care plan for the patient. The care plan comprises many vitals, activities, treatments etc. The provider can select the appropriate ones and create a care plan. The patient who has a mobile application gets notified about the care plan. He can go about recording data for the vitals or measurements given. Both the patient and the provider can view the data in form of graphs or tables which will help the provider to keep an eye on the patient’s vitals. The following features help the hospitals in monitoring the patients easily and thus reducing the readmission risks.

  1. Electronic Care Plans – Care plans to monitor patient’s vitals, measurements, etc. If required,  it can also be printed and handed over to the patient.
  2. Patient Reported Data – Patients can record data for all attributes in the care plan. Summary graphs and table data helps the provider in monitoring the patient’s vitals. The physicians can print reports at any time in pdf or excel form.
  3. Health Device Integration – HealthViewX Care Management Solution can integrate with any wearable device like Fitbit, Apple watch, etc. Hence the patients need not waste time in logging data in the application if they are already using wearables.
  4. Follow-up Appointments – The solution enables to schedule follow-up appointments and sends reminders to both the patient and the provider. It also has inbuilt audio and video calling features to support such meetings.

HealthViewX Care Management Solution offers a range of advantages and lessens the chances of a patient getting readmitted. To know more about our solution, schedule a demo with our expert team who will guide you through the process. Schedule a demo with us to learn more.

Annual Wellness Visit vs. Annual Physical Exam

Annual Wellness Visit vs. Annual Physical Exam

Annual Wellness Visit (AWV) is becoming increasingly significant in preventive healthcare services and there are many questions surrounding AWV and its actual benefits. Here is our answer to some of the trending questions:

Is Annual Wellness Visit the same as an Annual Physical Exam?

The immediate answer is a No, AWV is not the same as an annual physical exam. Medicare will cover an Annual Wellness visit but not an annual physical exam.  Under the Affordable Care Act (ACA), Medicare covers AWV completely, with no co-payment and no patient deductible. This is only valid  if the services provided during the visit meet specific criteria for information-gathering, assessment, and counseling.

What’s the difference between AWV and Annual Physical Exam in terms of patient assessment?

The premise of an Annual Physical Exam is to study the body and determine if there is any physical problem with the patient. On the other hand, the Annual Wellness Visit is to identify risks and then mitigate those risks by referring the patient to an appropriate resource.

Medicare Wellness is a holistic assessment routine

Annual Physical Exam is a measurement routine

  • The Doctor will measure height, weight, blood pressure and other routine measurements
  • The Doctor will assess your risk factors and treatment options
  • Review Health Risk Assessment questionnaire
  • Updating list of providers and prescriptions
  • Looking for signs of cognitive impairment
  • The Doctor will set up a screening schedule for appropriate preventive services
  • The Doctor will review your medical and family history
  • The Doctor will measure height and weight; blood pressure; BMI
  • The Doctor will assess your risk factors for preventable diseases
  • The Doctor will perform head and neck; lung; abdominal and neurological exams
  • The Doctor will check vital signs and test your reflexes
  • The Doctor may conduct any blood work or lab tests
  • The Doctor will review your medical and family history

The purpose of Annual Wellness Visit under Medicare is to record the current state of health and to create a starting point for the future. Medicare also covers a number of other preventive services such as preventive cancer screenings, bone density measurement, and flu shots free of cost.

The most important question would be – How is the delivery of an AWV— a preventive care service related to HealthCare Technology?

As a service, AWV is good for both patients and for HealthCare System’s Strategic Objectives. The manual processes involved in delivering AWV can be guided by an automated workflow tool. This tool can enable providers to create an assessment, create personalized care plans, set automated reminders, streamline documentation and educate the eligible population.

AWV intervention points for a tool/software platform like HealthViewX –

Patient eligibility verification Assessment/Scheduling of patient visit Patient visit/ Conducting the routine AWV reports Billing of Medicare CCM Suggestion
Done by HealthViewX Done by HealthViewX Done by Provider Done by HealthViewX, reviewed by Provider, shared with patients Done by Provider Suggest providers to enroll eligible patients for CCM

Empower your practice with HealthViewX’s smart and streamlined AWV and make the most out of Medicare’s profitable wellness program both for your practice and your patients.

Referral Software To Reduce Medical Errors & Repeated Efforts

With time and a strong push from Information technology, the healthcare industry is evolving. Every year, health IT companies bring new devices and tools aimed at reducing the burden on healthcare providers.

One particular healthcare industry problem that still seems to be elusive to the prowess of technology is medical errors. Essentially, Medical Errors are preventable negative effects of diagnosis or treatment.

Previously errors occurred because of improper utilization of data. Nowadays errors are made due to over-utilization of data. Physicians who preferred to use hi-tech devices are now afraid to use it. They are afraid because practices now use Electronic Health Record (EHR) and if one fails to update, the entire people involved in care will face difficulties.

In the USA, except for few practices, others have already implemented EHR system. These records are used to treat, refer, and to make all important clinical decisions. Physicians are put in a situation to handle too many data having a chance of causing errors. Most of the medical errors are made by physicians while utilizing these records in their busy schedule and these mistakes are directly tied up with patient records.

Likewise, errors are also made while referring a patient. Sometimes there is a possibility of sending wrong data while referring a patient. These incorrect referrals are found when referral coordinators call the wrong patient to confirm the appointments. At the same time, the concerned patient who needs a specialist visit will be waiting for the call to fix an appointment. This small error adds up over-time to cost-time, effort and money.

Repeated procedures are also another problem that contributes to the additional cost to patients which is not yet addressed by many hospitals. Patients are often requested to run repeat diagnosis and tests.

As requested patients will also repeat certain tests multiple times unknowingly by putting themselves in danger. Tests like CT scan and other imaging causes exposure to some radiations. By taking these tests multiple times they will end up with the high risk of getting cancer. Procedure repeat could be avoidable when all scanning image records are synced with an EHR. Timely update of all the patient-relevant details into their EHR will help to develop a better workflow.

The poor integration of EHR technology or medical device within a hospital is also noted as a potential cause of medical errors. Also, patients keep switching the network when they don’t find the right specialist. A practice with referral software will help to solve this problem.

A referral software enables smooth communication between the specialist and the PCP, PCPs will receive information back from the specialists. Improved communication with the help of referral solution could reduce medical errors and curb repeated tests and diagnosis.

A Referral Management Solution can Help the practice too,

1. Identify the right specialist
2. Closes communication gaps if any by enhancing the doctor-patient communication
3. Increase the utilization of medical records
4. Makes process simpler and effective
5. Reduce effort, time and repeated tests
6. Decrease wait time and scheduling problems

Why Referral Matters for Population Health?

Population Health has been the buzzword for some time now and is used excessively by healthcare providers of all kinds and large employers amongst others. One reason for this is, of course, the concept is in itself broad and can include many things.

The basic concept of population health can be defined as understanding healthcare needs of a patient population and proactive intervention based on group variations of healthcare requirements to achieve population health quality outcomes.

Population Health Management proposes a holistic approach to healthcare delivery and better outcome, that is the reason why managing referral network becomes important in the process.

Ensure Continuity of Care

The Providers participating in a population health model have a bigger stake in the continuity of care their patient population has been receiving.National statistics on referral indicates more than 40% of the referred patients do not go to recommended specialists therefore maybe unsettling to general providers. A referral Management solution can most definitely improve those numbers or at least identify the reasons why patients are reluctant to see a specialist.

Keeping the PCP in the Loop

An intelligent medical referral solution allows PCPs to consult with the specialist and make an informed decision in directing patient care. Referral management solution will ensure a good level of communication during and after the referral is complete. Primary providers in the absence of a medical referral solution have no means of knowing the status of the referral at regular intervals. After a referral Primary provider may not be able to know the specialist’s diagnosis and understand the outcome of the process closing the referral loop

Patient Population Requirements

The PCPs who consult several patients a day have no reliable well-documented source to understand the various needs of the population that they serve. The result of lack of capabilities will push PCPs to refer patients to specialists outside of their network to serve and address the needs of a patient.

Employing Analytics

Identifying the right data set from different sources to achieve the measureable outcome is not an easy task. Healthcare industry is slowly adapting to new age technologies and leveraging data insights from the information gathered by analytics tools. For example, if a PCP is able to evaluate the data from the past 6 to 12 months, it will help him understand the strength, weakness and yield more revenue opportunities for the practice and prevent revenue leakage through referrals made outside of the network.